重度主动脉瓣狭窄病人左心室舒张功能及生物标志物水平对预测肺动脉高压的价值

The value of left ventricular diastolic function and biomarker level in predicting pulmonary hypertension in patients with severe aortic stenosis

目的:探讨生物标志物联合左心室舒张功能常规超声心动图参数对重度主动脉瓣狭窄(AS)病人术前肺动脉收缩压(PSP)升高的预测价值。方法:选择60例重度AS(主动脉瓣面积<1 cm(2))病人,PSP≥45 mmHg诊断为肺动脉高压(PH),根据有无PH分为PH组18例和无PH组42例。行常规超声心动图、N端pro B型钠尿肽(NT-proBNP)和生长分化因子-15(GDF-15)检测。超声心动图评价PSP、左心室射血分数(LVEF)、左心室舒张功能参数E/E′、二尖瓣减速时间(MVDT)、左心房容积。分析左心室舒张功能参数及生物标志物水平与PSP的相关性。结果:PH组E/E′、左心房容积大于无PH组(P<0.05和P<0.01),MVDT小于无PH组(P<0.05)。AS病人NT-proBNP和GDF-15均高于正常上限。PH组病人NT-proBNP、GDF-15均高于无PH组(P<0.05)。2组病人NT-proBNP、GDF-15均随PSP的升高而升高(P<0.01)。E/E′比值>14、MVDT>177.5 ms、左心房容积>100 mL是严重AS病人发生PH的独立预测因子,NT-proBNP、GDF-15升高是预测PH的可靠指标(P<0.01)。结论:左心室舒张功能障碍和生物标志物水平升高可预测重度AS病人PH的发生与发展,为临床早期干预提供依据。

Objective:To investigate the predictive value of biomarker combined with conventional echocardiographic parameters of left ventricular diastolic function in preoperative pulmonary systolic pressure(PSP)in patients with severe aortic stenosis(AS).Methods:Sixty patients with severe AS(aortic valve area<1 cm(2))were selected.The PSP≥45 mmHg was diagnosed as the pulmonary arterial hypertension(PH),and the patients were divided into the PH group(18 cases)and nonPH group(42 cases).The routine echocardiography,N-terminal Pro B natriuretic peptide(NT-proBNP)and growth differentiation factor-15(GDF-15)were analyzed.The PSP,left ventricular ejection fraction(LVEF),left ventricular diastolic function parameters E/E′,mitral valve deceleration time(MVDT)and left atrial volume were evaluated.The correlation between left ventricular diastolic function parameters and biomarker level,and PSP were analyzed.Results:The E/E′and left atrial volume in PH group were larger than those in nonPH group(P<0.05 and P<0.01),and the MVDT in PH group was less than that in nonPH group(P<0.05).The levels of NT-proBNP and GDF-15 in AS patient were above the normal upper limit.The levels of NT-proBNP and GDF-15 in PH group were higher than those in nonPH group(P<0.05).The levels of NT-proBNP and GDF-15 in two groups increased with the increasing of PSP(P<0.01).The ratio of E/E′>14,MVDT>177.5,left atrial volume>100 mL are the independent predictors of PH occurrence in severe patients,and the levels increasing of NT-proBNP and GDF-15 were the reliable predictors of predictive PH(P<0.01).Conclusions:The increasing of the levels of left ventricular diastolic dysfunction and biomarkers can predict the development of pulmonary hypertension in patients with severe AS,and it can provide a basis for early intervention in pulmonary hypertension.